Document Detail


Utility of isoproterenol to provoke outflow tract gradients in patients with hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  18312769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
It is important to identify patients with hypertrophic cardiomyopathy (HC) who have labile left ventricular outflow tract (LVOT) obstruction for consideration of ventricular septal reduction therapy. Although Doppler echocardiography has become the diagnostic modality to assess LVOT obstruction, it may not identify all patients with labile obstruction. This study assessed the diagnostic value of cardiac catheterization using isoproterenol challenge in 25 patients with HC in whom an LVOT obstruction (gradient >or=50 mm Hg) was clinically suspected, but not diagnosed using Doppler echocardiography. These patients underwent cardiac catheterization using a transseptal approach with isoproterenol challenge. During isoproterenol infusion, the gradient increased to >or=50 mm Hg in 14 patients and remained <50 mm Hg in 11 patients. Ten patients subsequently underwent surgical myectomy, 6 patients underwent alcohol septal ablation, and 9 patients were managed medically. Median follow-up was 26 months. Of patients who had a provoked gradient >50 mm Hg during isoproterenol infusion, 8 patients who underwent septal myectomy and 5 of 6 patients who underwent alcohol septal ablation had sustained alleviation of symptoms at follow-up. In conclusion, cardiac catheterization with isoproterenol challenge may identify patients with HC who may benefit from septal reduction therapy for whom the initial noninvasive evaluation does not show severe obstruction.
Authors:
Ahmad Elesber; Rick A Nishimura; Charanjit S Rihal; Steve R Ommen; Hartzell V Schaff; David R Holmes
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Publication Detail:
Type:  Journal Article     Date:  2007-12-20
Journal Detail:
Title:  The American journal of cardiology     Volume:  101     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-03-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  516-20     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic beta-Antagonists / therapeutic use
Adult
Aged
Anti-Arrhythmia Agents / therapeutic use
Calcium Channel Blockers / therapeutic use
Cardiac Surgical Procedures
Cardiomyopathy, Hypertrophic / therapy*
Cardiotonic Agents / diagnostic use*
Disopyramide / therapeutic use
Ethanol / administration & dosage
Female
Heart Catheterization
Heart Septum / surgery
Humans
Isoproterenol / diagnostic use*
Male
Middle Aged
Retrospective Studies
Solvents / administration & dosage
Ventricular Outflow Obstruction / diagnosis*,  therapy
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; 0/Cardiotonic Agents; 0/Solvents; 3737-09-5/Disopyramide; 64-17-5/Ethanol; 7683-59-2/Isoproterenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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